Nearly three million older persons are housed in long-term care (LTC) settings. Until recently, most resided in nursing homes (NHs), but residential care/assisted living (RC/AL) facilities have been proliferating as alternatives to NH care. RC/AL facilities are extremely varied, ranging from small board and care homes to large complexes. The residents they serve also are diverse, and many resemble persons in NHs, including elderly with Alzheimer's Disease and related dementias. Despite the prevalence of RC/AL, research data in this area are sparse. The principal investigator has conducted statewide studies of NH care, and is currently conducting the largest study of the structure and process of care across RC/AL facilities, with the aim of identifying facility characteristics that relate to resident outcomes. Her involvement in these projects focusing on the quality of life and quality of care in NHs and RC/AL settings position her to undertake the aims of the proposed project. The focus of the proposed research is on three areas that are especially relevant in this evolving field: (1) the relationship between RC/AL quality of care and regulation; (2) health care utilization and cost in RC/AL compared to NHs; and (3) the implementation and evaluation of LTC policy using an outcomes-based perspective. This independent scientist application outlines three sets of activities to enhance the candidate s ability to make scholarly contributions to the field of RC/AL: working with national policy and RC/AL experts to compare facility characteristics that relate to outcomes to those addressed in existing regulations, culminating in manuscripts and the development of a demonstration project; working with health policy and LTC experts and receiving additional training toward the development of manuscripts and a application to use Medicare data to better understand issues of utilization and cost across RC/AL and NHs; and working with state regulators and health services research and policy experts to develop measures and protocols to monitor the implementation and outcomes of new LTC policies. Overall, the principal investigator's ultimate objective is to improve the quality of LTC for our nation's elderly.